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Neurosciences & Behavioral Sciences Module

2017 STUDY GUIDE


Class of

Module Year Spiral Duration Module Coordinator Year Coordinator Discipline Involved

Neuro Sciences for class of 2017 2014 01 year 2 12 Weeks Dr. Khadija Iqbal Dr. Khadija Iqbal (Associate Professor Anato y! Anato y Physiolo"y #ioche istry Phar acolo"y Patholo"y Psychiatry $edicine Pediatrics %o &nity edicine

$edical ed&cation

%'()*()+ Introduction ..4 Why do we need a study guide? 5 Why do we need an integrated curriculum? 6 Introduction to the module 7 Index of icons 14 Themes and o !ecti"es 15 #c$nowledgements 41 %esource material 41

I(),'D-%)I'(

to your 2nd year as a student. We are beg nn ng ! t" neuros# en#es $odule. T" s $odule ! ll run for 12 !ee%s and #o$&r ses 0' t"e$es t"at address d fferent fun#t ons of ner(ous syste$. T" s $odule s e)&e#ted to bu ld t"e student*s bas # %no!ledge about t"e nor$al stru#ture+ organ ,at on+ fun#t ons and de(elo&$ent of ner(ous syste$. T" s %no!ledge ! ll ser(e as a fabr # on !" #" t"e student ! ll !ea(e furt"er %no!ledge about t"e et ology+ &at"ology and &at"ogenes s of d seases of ner(ous syste$ and t"e &r n# &les of t"e r $anage$ent. #road .earnin" o&tco es of the At the end of od&le/

od&le the st&dents 0ill be able to/

Correlate t"e stru#tural as&e#ts of #entral ner(ous syste$ and -er &"eral ner(ous syste$ ! t" t"e r fun#t ons Correlate t"e stru#ture of t"e neurotrans$ tters ! t" t"e fun#t on ng of ner(ous syste$. Inter&ret t"e "u$an be"a( or n #onte)t of nor$al neuro&"ys olog #al fun#t ons. Dates to .e$e$ber/ +tart of 0odule 11111..2t" 3anuary+ 2013 $ d 0odule *nd 0odule

W12 D' W* (**D A +)-D2 3-ID* )' D*.I4*, %'()*() '5 A $'D-.*6 We do need a study gu de as an a d+ usually n t"e for$ of &r nted notes+ des gned to ass st students ! t" t"e r learn ng. 6 study gu de #an be seen as a $anage$ent tool !" #" allo!s t"e tea#"er to e)er# se " s res&ons b l t es !" le at t"e sa$e t $e g ( ng t"e student an $&ortant &art to &lay n $anag ng " s o!n learn ng. )1* P')*()IA. ,'.*+ of +)-D2 3-ID*+ I( 5A%I.I)A)I(3 .*A,(I(3 T"ese #an be #ategor ,ed nto t"ree grou&s/ 1. t"e $anage$ent of students* learn ng 2. t"e &ro( s on of a fo#us for students* a#t ( t es related to t"e learn ng7 3. t"e &ro( s on of nfor$at on on t"e sub8e#t or to& # 1! )he ana"e ent of st&dents7 learnin" T"e study gu de "el&s to do t" s t"roug" a9 Introdu# ng a #ourse/ T"e gu de sets t"e #ourse n t"e #onte)t of t"e #urr #ulu$. b9 : g"l g"t ng t"e e)&e#ted learn ng out#o$es/ T"e study gu de #an des#r be t"e a $s and ob8e#t (es of t"e #ourse and #an e)&la n to students !"at s e)&e#ted of t"e$ n ter$s of learn ng out#o$es #9 6ss st ng n &lann ng and del (er ng an ntegrated &rogra$$e/ T"e gu de #an br ng toget"er $ater al fro$ d fferent &ers&e#t (es !" #" relates to t"e #ourse and en#ourages t"e student to loo% at t"e to& # fro$ d fferent ( e!&o nts. d9 ;utl n ng t"e t $etable and learn ng o&&ortun t es a(a lable/ T"ese $ay n#lude for$al le#tures+ ot"er t $etabled a#t ( t es and o&&ortun t es for nd ( dual !or% and self<learn ng. 2! )he 8ro9ision of a foc&s for st&dents7 acti9ities related to the learnin" a9 To en#ourage students to ntera#t ! t" t"e #ourse/ 6#t ( t es n t"e study gu de &ro( de an ntera#t (e ele$ent to t"e students* learn ng+ and en"an#e t"e learn ng e)&er en#e. :! )he 8ro9ision of infor ation on the s&bject or to8ic ;##as onally+ tea#"ers feel a need to &ro( de students ! t" nfor$at on !" #" su&&le$ents !"at s &resented n le#tures or n ot"er resour#e $ater al. Trad t onally+ su#" nfor$at on !as &resented as ="andouts* t"at a##o$&an ed a le#ture or &ra#t #al #lass. T"e need for add t onal nfor$at on $ay ar se !"en/ a9 t"ere s a la#% of boo%s and resour#e $ater al7 b9 t"ere s a need to e$&"as ,e and " g"l g"t %ey or #ore nfor$at on7 #9 t"e sour#es of nfor$at on a(a lable are out of date or do not relate to t"e lo#al #onte)t7

W12 D' W* (**D A( I()*3,A)*D %-,,I%-.-$6 We need ntegrat on be#ause !e !ant to &rodu#e $ed #al graduates ! t" des rable e) t #o$&eten# es for a &"ys # an. T"e follo! ng Can<0eds<based e) t #o$&eten# es "a(e been #ons dered des rable for a graduat ng &"ys # an/ 6s a $edical *;8ert+ "e>s"e s"ould Establ s" and $a nta n #l n #al %no!ledge+ s% lls and att tudes re?u red to $eet t"e needs of t"e &ra#t #e and &at ent &o&ulat on ser(ed. De$onstrate &rof # ent assess$ent and $anage$ent of &at ents us ng t"e &at ent< #entered #l n #al $et"od -ro( de #o$&re"ens (e and #ont nu ng #are t"roug"out t"e l fe #y#le n#or&orat ng a&&ro&r ate &re(ent (e+ d agnost # and t"era&eut # nter(ent ons 6ttend to #o$&le) #l n #al s tuat ons n fa$ ly $ed # ne effe#t (ely De$onstrate &rof # ent and e( den#e<based use of &ro#edural s% lls 6s a %o &nicator< "e>s"e s"ould De(elo& ra&&ort+ trust and et" #al t"era&eut # relat ons" &s ! t" &at ents and fa$ l es 6##urately #on(ey needed nfor$at on and e)&lanat ons to &at ents and fa$ l es+ #olleagues and ot"er &rofess onals De(elo& a #o$$on understand ng on ssues+ &roble$s and &lans ! t" &at ents and fa$ l es+ #olleagues and ot"er &rofess onals to de(elo&+ &ro( de and follo!<u& on a s"ared &lan of #are Con(ey effe#t (e oral and !r tten nfor$at on 6s a %ollaborator< "e>s"e s"ould -art # &ate n a #ollaborat (e tea$<based $odel and ! t" #onsult ng "ealt" &rofess onals n t"e #are of &at ents 6s a $ana"er< "e>s"e s"ould -art # &ate n a#t ( t es t"at #ontr bute to t"e effe#t (eness of t"e r o!n &ra#t #e+ "ealt"#are organ ,at ons and syste$s 0anage t"e r &ra#t #e and #areer effe#t (ely 6s a 1ealth Ad9ocate< "e>s"e s"ould .es&ond to nd ( dual &at ent "ealt" needs and ssues as &art of &at ent #are .es&ond to t"e "ealt" needs of t"e #o$$un t es t"at t"ey ser(e 6s a +cholar< "e>s"e s"ould 0a nta n and en"an#e &rofess onal a#t ( t es t"roug" ongo ng self<d re#ted learn ng based on refle#t (e &ra#t #e Cr t #ally e(aluate $ed #al nfor$at on+ ts sour#es+ and ts rele(an#e to t"e r &ra#t #e+ and a&&ly t" s nfor$at on to &ra#t #e de# s ons @a# l tate t"e edu#at on of &at ents+ fa$ l es+ tra nees+ ot"er "ealt" &rofess onal #olleagues+ and t"e &ubl #+ as a&&ro&r ate Contr bute to t"e #reat on+ d sse$ nat on+ a&&l #at on+ and translat on of ne! %no!ledge and &ra#t #es 7

6s a Professional< "e>s"e s"ould De$onstrate a #o$$ t$ent to t"e r &at ents+ &rofess on+ and so# ety t"roug" et" #al &ra#t #e De$onstrate a #o$$ t$ent to t"e r &at ents+ &rofess on+ and so# ety t"roug" &art # &at on n &rofess on<led regulat on %'$P*)*(%I*+ 5'%-+*D I( )1I+ $'D-.* T"e follo! ng e) t #o$&eten# es "a(e been s&e# f #ally re?u red fro$ t"e learner n t"e $odule of neuros# en#es/ %o &nicator/ T"e learner s"ould #o$$un #ate effe#t (ely ! t" &eers and tea#"ers for$ally n learn ng sess ons+ grou& d s#uss ons and &resentat ons nfor$ally on a one<toAone bas s %ollaborator/ T"e learner s"ould #ollaborate effe#t (ely ! t" n t"e grou& ! t" t"e &ur&ose of e$&loy ng t"e #o$b ned ! sdo$ of grou& $e$bers to en"an#e %no!ledge and f ll n t"e %no!ledge ga&s dent f ed dur ng d s#uss ons ! t" t"e fa# l tators to a#" e(e t"e abo(e ob8e#t (es+ and de( se strateg es t"at !ould fa# l tate learn ng $ana"er/ T"e learner s"ould $anage " s o!n learn ng and t"at of " s &eers t"e learn ng of " s grou& !"en as%ed to do so +cholar/ T"e learner s"ould str (e to #r t #ally a&&ra se t"e %no!ledge &resented to " $ a&&ly t"e %no!ledge to understand nor$al fun#t on ng of our body syste$ d sse$ nate t"e %no!ledge ga ned a$ongst " s &eers ga n a##ess to Bu&<to<dateC nfor$at on Professional/ T"e learner s"ould de$onstrate a " g" le(el of #o$$ t$ent to!ards learn ng de$onstrate t"e et" #al and $oral (alues e)&e#ted of a learner D&un#tual ty+ "onesty+ "onor+ res&e#t9 refle#t #ont nually on " s learn ng &ra#t #e

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.*A,(I(3 +),A)*3I*+ Eearn ng strateg es ! ll be a #o$b nat on of all of t"e follo! ng de&end ng u&on t"e learn ng ob8e#t (es to be a#" e(ed/ +3Ds/ Small group learning is the learning that takes place when students work together
usually in groups of 10 or less. Some groups may work effectively with a larger number of participants. What matters is that the group shows three characteristics: i. Active participation: A key feature of small group work is that interaction should take place among all present. ii. A specific task: There should be a clearly defined task and ob ectives! and they should be understood by all members of the group. iii. Reflection: "n small group learning! it is important to learn from an e#perience and to modify behavior accordingly. $eep learning is a key feature of small group work: reflection is a key feature of deep learning.

.ar"e 3ro&8 +essions (.3I+!/ T"ese ! ll be used to #lar fy #on#e&ts or &resent an o(er( e! of a #erta n #o$&onent of t"e #ourse. T"ey s"ould be truly ntera#t (e and not a one<!ay le#ture. +kill +essions/ S% ll sess ons ! ll be about " story ta% ng and &"ys #al e)a$ nat on s% lls. In : stology lab t"ese sess ons ! ll be #ondu#ted for dent f #at on of $ #ros#o& # features of ner(ous t ssue and n &"ys ology lab for e)a$ nat on of ner(ous syste$. +D./ It en#ourages refle#t on u&on and #ontrol of learn ng a#t ( t es and de(elo&$ent of self< regulatory s% lls #ondu# (e to l felong learn ng. De onstrations/ @or 6nato$y t"ese are #ondu#ted for dent fy ng gross features of bra n and s& nal #ord. .ect&res/ @or so$e learn ng ob8e#t (es le#tures ! ll be used. 6 !ell < stru#tured le#ture ! t" e)&l # t learn ng ob8e#t (es+ def ned #onte)tual relat ons" &s and l n%age of t"eory to e)&er en#e s $ore l %ely to $a) $ ,e t"e learn ng o&&ortun ty for t"ose attend ng t"e le#ture. -re&arat on by t"ose attend ng t"e le#ture as !ell as t"ose organ , ng and s&ea% ng ! ll en"an#e t"e edu#at onal e)&er en#e.

A++*++$*() Su$$at (e assess$ent #o$&r s ng of End $odule e)a$ #onta n ng $#?s and Se?s ! ll be #ondu#ted at t"e end of $odule. 0 d $odule e)a$s ! ll also be #ondu#ted. @or$at (e assess$ent ! ll be #arr ed out t"roug"out t"e $odule. Ea#" learn ng sess on ! ll be assessed nfor$ally by t"e fa# l tators to e(aluate ts effe#t (eness+ and &ro( de &os t (e feedba#% to t"e learners ! t" an a $ to strengt"en t"e r !ea%nesses. 6 !ell < des gned &rogra$$e of for$at (e assess$ent l n%ed to o(erall #urr #ulu$ a $s and t"e tea#" ng and learn ng goals of nd ( dual $odules en"an#es t"e learn ng e)&er en#e for students. So$e sess ons ! ll be a##o$&an ed by ?u ,,es to enable you to assess your learn ng. Effe#t (e feedba#% s #entral to t"e &ro#ess of for$at (e assess$ent. .egular feedba#%s ! ll be ta%en fro$ you to ensure a#" e(e$ent of learn ng out#o$es. -ortfol o ! ll be used for re#ord ng &erfor$an#e t"roug"out t"e year. )he es 1. 6 d abet # !o$an ! t" nu$bness and & n&r #% sensat on n feet 2. &atient with s'inal trauma 3. &atient with difficulty in articulation and swallowing 4. &atient with wide ased gait and tendency of falling at one side Wei"hta"e 2=> 10> 20> =>

=> 5. # 'atient with resting tremors( shuffling gait. )as$ li$e face

2. # new orn with enlarging head and *sunset+ a''earance of eyes

=>

7. # young girl o sessed with, figure'. &atient with unilateral lim 'aralysis and s'eech disorder

=> 20>

F. Ina ility to recall recent e"ent 10. &atient with unilateral droo'ing eyelids constricted 'u'il and dry face

=> =>

10

I(),'D-%)I'( )' )1* $'D-.* ((*-,'+%I*(%*+ A(D #*1A4I'-,A. +%I*(%*+! Di9isions of the (er9o&s +yste T"e ner(ous syste$ #an be d ( ded nto t"e #entral and t"e &er &"eral ner(ous syste$s. T"e #entral ner(ous syste$ DCGS9 #ons sts of t"e bra n and s& nal #ord. T"e bra n "as se(eral reg ons l %e $edulla oblongata+ &ons+ #erebellu$+ $ dbra n+ #erebru$ and #erebral "e$ s&"eres. +8inal %ord T"e s& nal #ord s a #yl nder of ner(ous t ssue t"at beg ns at t"e base of t"e bra n and e)tends t"roug" a large o&en ng n t"e s%ull #alled t"e fora$en $agnu$. T"e s& nal #ord s &rote#ted by t"e (ertebral #olu$n+ !" #" s #o$&osed of nd ( dual (ertebrae. T"e #ord &asses t"roug" t"e (ertebral #anal for$ed by o&en ngs n t"e (ertebrae. It ends at t"e f rst lu$bar (ertebra. T"e s& nal #ord &ro( des a $eans of #o$$un #at on bet!een t"e bra n and t"e &er &"eral ner(es t"at lea(e t"e #ord. W"en so$eone tou#"es your "and+ sensory re#e&tors generate ner(e $&ulses t"at &ass t"roug" sensory f bers to t"e s& nal #ord and u& one of se(eral as#end ng tra#ts to a sensory area of t"e bra n. W"en you (oluntar ly $o(e your l $bs+ $otor $&ulses or g nat ng n t"e bra n &ass do!n one of se(eral des#end ng tra#ts to t"e s& nal #ord and out to your $us#les by !ay of $otor f bers. T"e 0ed #al @o#us on t" s &age d s#usses !"at "a&&ens f t"e s& nal #ord s n8ured. We ! ll see t"at t"e s& nal #ord s also t"e #enter for t"ousands of refle) ar#s. 6 st $ulus #auses sensory re#e&tors to generate ner(e $&ulses t"at tra(el n sensory neurons to t"e s& nal #ord. Interneurons ntegrate t"e n#o$ ng data and relay s gnals to $otor neurons. 6 res&onse to t"e st $ulus o##urs !"en $otor a)ons #ause s%eletal $us#les to #ontra#t. Ea#" nterneuron n t"e s& nal #ord "as syna&ses ! t" $any ot"er neurons+ and t"erefore t"ey send s gnals to se(eral ot"er nterneurons n add t on to $otor neurons. #rainste T"e Hra n Ste$ #onta ns t"e $ dbra n+ t"e -ons+ and t"e $edulla oblongata. T"e $ dbra n a#ts as a relay stat on for tra#ts &ass ng bet!een t"e #erebru$ and t"e s& nal #ord or #erebellu$. It also "as refle) #enters for ( sual+ aud tory+ and ta#t le res&onses. T"e !ord &ons $eans Bbr dgeC n Eat n+ and true to ts na$e+ t"e &ons #onta ns bundles of a)ons tra(el ng bet!een t"e #erebellu$ and t"e rest of t"e CGS. In add t on+ t"e &ons fun#t ons ! t" t"e $edulla oblongata to regulate breat" ng rate and "as refle) #enters #on#erned ! t" "ead $o(e$ents n res&onse to ( sual and aud tory st $ul . T"e $edulla oblongata #onta ns a nu$ber of refle) #enters for regulat ng "eartbeat+ breat" ng+ and (aso#onstr #t on. It also #onta ns t"e refle) #enters for (o$ t ng+ #oug" ng+ snee, ng+ " ##u&& ng+ and s!allo! ng. T"e $edulla oblongata l es 8ust su&er or to t"e s& nal #ord+ and t #onta ns tra#ts t"at as#end or des#end bet!een t"e s& nal #ord and " g"er bra n #enters. )he %erebell& T"e #erebellu$ s se&arated fro$ t"e bra n ste$ by t"e fourt" Ientr #le. T"e #erebellu$ "as t!o &ort ons t"at are 8o ned by a narro! $ed an &ort on. Ea#" &ort on s &r $ar ly #o$&osed of !" te $atter+ !" #" n long tud nal se#t on "as a treel %e &attern. ;(erly ng t"e !" te $atter s a t" n layer of gray $atter t"at for$s a ser es of #o$&le) folds. T"e #erebellu$ re#e (es sensory n&ut fro$ t"e eyes+ ears+ 8o nts+ and $us#les about t"e &resent &os t on of body &arts. It also re#e (es $otor out&ut fro$ t"e #erebral #orte) about !"ere t"ese &arts s"ould be lo#ated. 6fter ntegrat ng t" s nfor$at on+ t"e #erebellu$ sends $otor $&ulses by !ay of t"e bra n ste$ to t"e s%eletal $us#les. In t" s !ay+ t"e #erebellu$ $a nta ns &osture and balan#e. It also ensures t"at all of t"e $us#les !or% toget"er to &rodu#e s$oot"+ #oord nated (oluntary $o(e$ents. In add t on+ t"e #erebellu$ ass sts t"e learn ng of ne! $otor s% lls+ su#" as &lay ng t"e & ano or " tt ng a baseball. 11

#asal (&clei W" le t"e bul% of t"e #erebru$ s #o$&osed of tra#ts+ t"ere are $asses of gray $atter lo#ated dee& ! t" n t"e !" te $atter. T"ese so<#alled basal nu#le Dfor$erly ter$ed basal gangl a9 ntegrate $otor #o$$ands+ ensur ng t"at &ro&er $us#le grou&s are a#t (ated or n" b ted. :unt ngton d sease and -ar% nson d sease+ !" #" are bot" #"ara#ter ,ed by un#ontrollable $o(e$ents+ are bel e(ed to be due to an $balan#e of neurotrans$ tters n t"e basal nu#le . .i bic +yste T"e l $b # syste$ l es 8ust nfer or to t"e #erebral #orte) and #onta ns neural &at"!ays t"at #onne#t &ort ons of t"e #erebral #orte) and t"e te$&oral lobes ! t" t"e t"ala$us and t"e "y&ot"ala$us/ sub8e#t to e)&er en#e rage+ &a n+ &leasure+ or sorro!. Hy #aus ng &leasant or un&leasant feel ngs about e)&er en#es+ t"e l $b # syste$ a&&arently gu des t"e nd ( dual nto be"a( or t"at s l %ely to n#rease t"e #"an#e of sur( (al. T"e l $b # syste$ s also n(ol(ed n learn ng and $e$ory. Eearn ng re?u res $e$ory+ and $e$ory s stored n t"e sensory reg ons of t"e #erebru$+ but 8ust !"at &er$ ts $e$ory de(elo&$ent s not def n tely %no!n. T"e n(ol(e$ent of t"e l $b # syste$ n $e$ory e)&la ns !"y e$ot onally #"arged e(ents result n our $ost ( ( d $e$or es. T"e fa#t t"at t"e l $b # syste$ #o$$un #ates ! t" t"e sensory areas for tou#"+ s$ell+ ( s on+ and so fort" a##ounts for t"e ab l ty of any &art #ular sensory st $ulus to a!a%en a #o$&le) $e$ory )he Peri8heral (er9o&s +yste (P(+! Cons sts of ner(es and gangl a+ !" #" l e outs de t"e CGS+ t"e -GS "as t!o subd ( s ons/ T"e afferent d ( s on #ondu#ts a#t on &otent als fro$ sensory re#e&tors to t"e CGS. T"e neurons t"at trans$ t a#t on &otent als fro$ t"e &er &"ery to t"e CGS are afferent neurons. T"e efferent d ( s on #ondu#ts a#t on &otent als fro$ t"e CGS to effe#tor organs su#" as $us#les and glands. T"e neurons t"at trans$ t a#t on &otent als fro$ t"e CGS to!ard t"e &er &"ery are efferent neurons. T"e efferent d ( s on #an be furt"er subd ( ded nto t"e so$at # $otor ner(ous syste$+ !" #" trans$ ts a#t on &otent als fro$ t"e CGS to s%eletal $us#les+ and t"e autono$ # ner(ous syste$ D6GS9+ !" #" trans$ ts a#t on &otent als fro$ t"e CGS to #ard a# $us#le+ s$oot" $us#le+ and glands. T"e autono$ # ner(ous syste$+ n turn+ s d ( ded nto sy$&at"et # and &arasy$&at"et # &ort ons. T"e sy$&at"et # d ( s on &re&ares t"e &erson for &"ys #al a#t ( ty+ !"ereas t"e &arasy$&at"et # d ( s on a#t (ates fun#t ons su#" as d gest on t"at are nor$ally asso# ated ! t" t"e body at rest. #eha9ioral +cience He"a( oral s# en#e g (es fas# nat ng ns g"ts nto "u$an be"a( or and ! de rang ng &ra#t #al $&l #at ons. He"a( oral s# en#e see%s to ans!er %ey ?uest ons about "o! &eo&le be"a(e and !"at nfluen#es t"e de# s ons t"ey $a%e+ for e)a$&le/ W"at deter$ nes !"et"er &eo&le are $&uls (e+ ta%e r s%s+ or #oo&erateJ W"at fa#tors nfluen#e be"a( oral #"angeJ W"at nfluen#e do d fferent #ultures so# et es "a(e on "u$an be"a( orJ

12

I(D*? '5 I%'(+ Introdu#t on to C6SE/

@or ;b8e#t (es/

T" s I#on ! ll refer to #r t #al ?uest ons/

T" s I#on ! ll refer to : stology Eab sess ons/

Eearn ng resour#es/

13

)1*$*+ A(D .*A,(I(3 '#@*%)I4*+


19 # dia etic woman with num ness and 'in'ric$ sensation in feet 29 &atient with s'inal trauma 39 &atient with difficulty in articulation and swallowing 49 &atient with wide ased gait and tendency of falling at one side 59 # 'atient with resting tremors( shuffling gait. )as$ li$e face 29 # new orn with enlarging head and *sunset+ a''earance of eyes 79 # young girl o sessed with, figure'9 &atient with unilateral lim 'aralysis and s'eech disorder F9 Ina ility to recall recent e"ent 109 &atient with unilateral droo'ing eyelids constricted 'u'il and dry face ..5 Wee$ 1.5 Wee$ 1./ Wee$ 1./ Wee$ /.5 Wee$ 1./ Wee$ /.5 Wee$ 1.5 Wee$s /.5 Wee$ 1./ Wee$

14

)1*$* A 01
A DIA#*)I% W'$A( WI)1 (-$#*,+ A(D PI(P,I%K +*(+A)I'( I( 5**)

Introdu#t on to #ase 6 5F year old !o$an ! t" ty&e 2 d abetes &resents n ;-D ! t" C>; nu$bness K & ns K needle sensat ons n "er feet for t"e &ast 10 $ont"s. ;(er t"e last 04 $ont"s t"e sy$&to$s "a(e !orsened. S"e also "as d ,, ness on gett ng u& fro$ bed n $orn ng for last 04 $ont"s. Past $edical 1istory S"e s %no!n ty&e 2 d abet # for last 02 years K s on oral "y&ogly#e$ # for #ontrol of "er sugar le(els. S"e s also a %no!n "y&ertens (e for 04 years K s on regular ant <"y&ertens (e $ed #at on. 5a ily 1istory S"e s $arr ed and l (es ! t" "er "usband and 2 daug"ters aged 21 and 1'. 6ll are "ealt"y. :er $ot"er also "ad d abetes and s"e d ed of renal fa lure 14 years ba#%. Personal 1istory S"e s a non s$o%er. S"e s #urrently on no ot"er $ed #at ons e)#e&t ant "y&ertens (es and oral "y&ogly#e$ #. +yste ic ,e9ie0 CIS/ unre$ar%able .es&/ unre$ar%able GIT/ unre$ar%able CGS/ as abo(e *;a ination 3P*/ S"e s alert and #ons# ous ! t" ( tals of H.-/ 150>100$$"g on s tt ng and 120>F0$$"g on stand ng -ulse/ '4 b&$ regular Te$&7 F'@ .>./ 1'>$ n %4+/ unre$ar%able 3I)/ unre$ar%able %hest/ unre$ar%able %(+/ :0@ Inta#t $otor syste / Inta#t %.(/ Gor$al +ensory syste / .edu#ed tou#" sensat on of sto#% ng ty&e n feet .edu#ed &a n+ &os t on and te$&erature sensat ons n feet 15

6ll sensat ons nor$al n "ands -ro) $al 0yo&at"y L (e .o$berg*s s gn L (e Ga t and #erebellu$/ Inta#t

At the end of the

odule students should !e a!le to"#

G (e an ;(er( e! of $a8or le(els of ner(ous syste$ fun#t on ng. Class fy sensory re#e&tors. Des#r be t"e $e#"an s$ of transdu#t on of sensory st $ul nto ner(e $&ulse. Des#r be t"e $e#"an s$ of ada&tat on of re#e&tors Des#r be t"e $e#"an s$ of &ro#ess ng and trans$ ss on of s gnals n neuronal &ools. D fferent ate bet!een te$&oral and s&at al su$$at on Des#r be t"e &"eno$ena of .e(erberat on Class fy t"e so$at # sensat ons Des#r be t"e &at"!ays for trans$ tt ng (ar ous sensory $odal t es to t"e #erebral #orte) D fferent ate bet!een dorsal #olu$n<$ed al le$n s#al syste$ and anterolateral syste$ n trans$ tt ng so$at # s gnals nto CGS. Des#r be t"e &"ys olog #al organ ,at on and fun#t ons of so$atosensory #orte) Enl st d fferent ty&es of &a n. D fferent ate bet!een fast and slo! &a n Des#r be t"e &at"!ays for &a n trans$ ss on and su&&ress on Understand t"e #on#e&t of 6nalges a syste$ n body Enl st t"e #"e$ #al $ed ators n(ol(ed n analges a syste$ Des#r be t"e $e#"an s$ of st $ulat on of t"er$al re#e&tors Inter&ret neurolog #al &resentat on of les ons at d fferent le(els n t"e sensory syste$. D fferent ate bet!een ( s#eral &a n and so$at # &a n Des#r be t"e $e#"an s$ of a#t on of o& ods and GS6IDS. D s#uss t"e fa#tors affe#t ng &er#e&t on of &a n.D&sy#" atry9 +KI.. De$onstrate t"e General -"ys #al E)a$ nat on on g (en sub8e#t De$onstrate t"e #l n #al $et"ods n(ol(ed n sensory syste$ e)a$ nat on on g (en sub8e#t. A))I)-D* .es&e#t ng e(ery "u$an be ng and ab d ng by rele(ant Isla$ # et" #s 6 des re to ease &a n and suffer ng W ll ngness to !or% n a tea$ ! t" ot"er "ealt" &rofess onals 12

.es&ons b l ty to re$a n a l fe<long learner and $a nta n t"e " g"est et" #al and &rofess onal standards

:o! s t"ala$us related to ot"er &arts of ner(ous syste$ stru#turally and fun#t onallyJ W"at s t"e role of t"ala$ # nu#le n t"e sensory syste$J :o! do #onne#t ons bet!een t"ala$us and #erebral #orte) affe#t t"e fun#t on ng of t"e latterJ W t" t"ala$us :o! s t"e sensory syste$ organ ,edJ :o! are t"e (ar ous sensory $odal t es #on(eyed to t"e #erebral #orte)J W"at are t"e &at"!ays for &a n trans$ ss on and su&&ress onJ :o! does ( s#eral &a n d ffer fro$ so$at # &a nJ

17

)1*$* A 02
PA)I*() WI)1 +PI(A. ),A-$A

Introd&ction to %A+*/ Gul M"an !as a 30<year<old bus dr (er. W" le &erfor$ ng t"e rout ne duty "e !as atta#%ed by stray bullet. T"e bullet s$as"ed " s T7 (ertebra and se(ered " s s& nal #ord. Hefore and after t"e surg #al &ro#edures t"at re&a red t"e da$age as $u#" as &oss ble+ " s legs !ere l $& and stret#" refle)es !ere absent. T"ere !as total sensory loss belo! t"e T10 der$ato$e. : s ur nary bladder !as #at"eter ,ed+ be#ause ! t"out t" s t"e bladder d stended to greater t"an nor$al s ,e+ unt l s$all a$ounts of ur ne dr bbled out. Heg nn ng at about 5 !ee%s after t"e n8ury+ stret#" refle)es began to return and b lateral Hab ns% s gns a&&eared. Hy about 10 !ee%s " s lo!er l $bs !ere s&ast #. ;(er t"e sa$e &er od+ " s detrusor began #ontra#t ng for#efully at lo!er t"an nor$al (olu$es7 des& te t" s+ t"e bladder fa led to e$&ty #o$&letely+ so #at"eter ,at on "ad to be #ont nued. Past $edical 1istory Go "os& tal ,at on. 5a ily 1istory :e s $arr ed ! t" 2 % ds. Personal 1istory Gon s$o%er +yste atic ,e9ie0 (e&ro < : s legs !ere l $& and stret#" refle)es !ere absent. T"ere !as total sensory loss belo! t"e T10 der$ato$e. Heg nn ng at about 5 !ee%s after t"e n8ury+ stret#" refle)es began to return and b lateral Hab ns% s gns a&&eared. Hy about 10 !ee%s " s lo!er l $bs !ere s&ast #. -rinary < : s ur nary bladder !as #at"eter ,ed+ be#ause ! t"out t" s t"e bladder d stended to greater t"an nor$al s ,e+ unt l s$all a$ounts of ur ne dr bbled out.

At the end of the course students should !e a!le to"# Correlate t"e stru#ture of #o$&onents of ner(ous t ssue to t"e r fun#t on. E)&la n t"e &ro#ess of n8ury to ner(e t ssue. Correlate t"e stru#ture of s& nal #ord ! t" fun#t on Des#r be neurulat on and transfor$at on of neural tube nto #entral ner(ous syste$. State e$bryolog #al bas s and &resentat on of neural tube defe#ts. Des#r be t"e ty&es and &ro&ert es of syna&se Des#r be t"e fa#tors affe#t ng syna&t # trans$ ss on. 1'

;utl ne t"e ste&s n(ol(ed n syna&t # trans$ ss on Co$&are t"e role of d fferent neurotrans$ tters n(ol(ed n syna&ses. Des#r be t"e $e#"an s$ of rest ng $e$brane &otent al of neuronal so$a. D st ngu s" bet!een E-S- and I-S-. Des#r be t"e organ ,at on of s& nal #ord for $otor fun#t on. Des#r be t"e &"ys olog #al anato$y of $us#le s& ndle Class fy $us#le sensory re#e&tors and des#r be t"e r roles n $us#le #ontrol. ;utl ne t"e #o$&onents of $us#le stret#" refle) Class fy s& nal #ord refle)es Correlate t"e bas s of s& nal refle)es ! t" t"e r derange$ents. ;utl ne t"e refle)es of &osture and lo#o$ot on. D s#uss t"e effe#ts of s& nal #ord transa#t on and s& nal s"o#%. Des#r be t"e bas s of neurolog #al s gns seen after re#o(ery fro$ s& nal s"o#%. Des#r be t"e $e#"an s$ of a#t on of lo#al anaest"et #s n#lud ng s& nal anaest"es a

+KI..
D fferent ate (ar ous seg$ents of s& nal #ord on " stolog #al se#t ons. De$onstrate organ ,at on and fun#t onal lo#at on of gray and !" te $atter n s& nal #ord. Ident fy t"e gross features of s& nal #ord along ! t" blood su&&ly and $en nges on t"e g (en s&e# $en>$odel. Ident fy t"e atta#"$ent of Dural (enous s nuses n t"e s%ull -erfor$ $otor e)a$ nat on of l $bs D0us#le Tone+ Tendon 3er%s+ and Su&erf # al .efle)es9 6d$ n strat on of lu$bar &u#ture>s& nal anaest"es a A))I)-D* 6ble to #ounsel &at ent ! t" s& nal trau$a

:o! !ould you #orrelate bet!een s& nal #ord seg$ent and (ertebraeJ :o! does t"e stru#ture of s& nal #ord refle#ted n ts fun#t onsJ W"at s t"e role of " g"er #enters n s& nal #ord fun#t onsJ :o! does grey and !" te $atter de(elo&J :o! do neural tube defe#ts #o$$only &resentJ W"at s t"e &resentat on of s& nal s"o#% and ts bas sJ 1F

W"at s t"e bas s of neurolog #al s gns seen after re#o(ery fro$ s& nal s"o#%

20

)1*$* A 0:
PA)I*() WI)1 DI55I%-.)2 I( A,)I%-.A)I'( A(D +WA..'WI(3

Introd&ction to %A+*/ 6 22 year old ret red s#"ool tea#"er &resented ! t" &rogress (e !ea%ness and fat gue. :e "as d ff #ulty #l $b ng sta rs K "as not #ed t"at "e "as d ff #ulty "old ng ob8e#ts ! t" " s left "and. ;(er t"e &ast !ee% " s ! fe "ad not #ed t"at " s s&ee#" a&&eared slurred K nasal K "e !as "a( ng d ff #ulty s!allo! ng " s $eals. Past $edical 1istory Go "os& tal ,at on. 5a ily 1istory :e s $arr ed ! t" 2 % ds. : s ! fe K % ds are all "ealt"y. : s &arents and s bl ngs are also "ealt"y. +ocioecono ic 1istory : s son s a ban% $anager K sole bread A earner of fa$ ly "e earns about 20+000>< &er $ont". Personal 1istory :e s an e)<# garette s$o%er. :e used to s$o%e 05 # garettes a day for 15 years. +yste atic ,e9ie0 CIS< Unre$ar%able .es&< Unre$ar%able Ur nary > 0SM< Unre$ar%able GTI<Unre$ar%able Geuro <6s n " story

*;a ination 3P*/ :e s #ons# ous K alert ! t" ( tals of H.- < 120>'5 $$"tg -ulse '4b&$ regular .>. 1'>$ n Te$& F'@ %4+/ Unre$ar%able Abdo en/ Unre$ar%able ,es8/ Unre$ar%able %(+ :0@< Inta#t -at ent "as dysart"r a %.( e;a ination < Tongue $o(e$ents are slugg s" < E;0<Gor$al < Wast ng K fas# #ulat on of s$all $us#les of left "and < Tone K &o!er redu#ed n left u&&er l $b K u&&er l $b refle)es are br s% < 6lso rest ng fas# #ulat on of $us#les of bot" " &s $us#les. 21

< Tone and -o!er redu#ed. 6n%le K %nee refle)es are br s%. +ensations are nor$al. %erebell& < Inta#t 5&nd&s < Gor$al

At the end of the odule students should !e a!le to"# Correlate e)ternal and nternal features of bra n ste$ and ts fun#t ons to d fferent #l n #al &resentat ons. Dra! and label #ross se#t ons of bra nste$ at d fferent le(els 6naly,e fun#t ons of ret #ular a#t (at ng syste$. Correlate t"e blood su&&ly of bra nste$ to #l n #al effe#ts of (as#ular o##lus on. Correlate #ran al ner(e les ons to t"e r &at"!ay. Correlate e)ternal and nternal features of bra n ste$ and ts fun#t ons to d fferent #l n #al &resentat ons. 6naly,e fun#t ons of ret #ular a#t (at ng syste$. Des#r be t"e role of bra nste$ n #ontroll ng $otor fun#t ons. Des#r be t"e $e#"an s$ by !" #" body $a nta ns tone and &osture D fferent ate bet!een u&&er $otor neuron les ons of #ran al ner(es fro$ lo!er $otor neuron les ons. D fferent ate bet!een G.E0 and .E0 slee& D s#uss sedat (es and "y&not #s D fferent ate bet!een d fferent ty&es of bra n !a(es n t"e nor$al ele#troen#e&"alogra$. Co$&are Grand 0al E& le&sy ! t" -et t 0al and @o#al E& le&sy. Des#r be t"e drugs used for treat$ent of E& le&sy

+KI.. Ident fy t"e features of nter or of s%ull. Ident fy t"e (ar ous fora$ na and stru#tures &ass ng t"roug" t"e$. Ident fy t"e gross features of bra nste$ on g (en $odel>s&e# $en. De$onstrate t"e #l n #al $et"ods n(ol(ed n e)a$ nat on of #ran al ner(es on a g (en sub8e#t 22

:o! does bra nste$ &erfor$ ts role n ner(ous syste$J W"at s t"e fate of sensory and $otor tra#ts n bra nste$ and t"e r relat on to #l n #al &resentat on of bra nste$ les onJ W"y are features of u&&er $otor neuron les ons of #ran al ner(es d fferent fro$ lo!er $otor neuron les onsJ :o! do ty&es of slee& d ffer fro$ ea#" ot"erJ :o! does slee& $e#"an s$ !or%J

23

)1*$* A 04
PA)I*() WI)1 WID* #A+*D 3AI) A(D )*(D*(%2 '5 5A..I(3 )' '(* +ID*

Introd&ction to %A+* S"eraa,+ a 3 years $ale #" ld+ .es dent of 3"ang Syedan &resented n ;-D of 6lGafees $ed #al "os& tal. :e !as !ell 2 days ba#% !"en "e de(elo&ed $ult &le e& sodes of (o$ t ng. :e s unable to !al% for t"e last 1 day and "as d ,, ness and fre?uent falls.T"ere s no " story of fe(er+ f ts+ &"oto&"ob a+ "eada#"e or ear d s#"arge. Go " story of loose $ot ons+ 8aund #e et#. Past 1istory : story of fe(er and &ustular ras"+ 3 !ee%s ba#% !" #" "ealed #o$&letely n 7<10 days. Go " story of nta%e of any drugs. #irth 1istory Une(entful De9elo8 ental 1istory De(elo&$entally nor$al 4accination 1istory @ully (a## nated a##ord ng to E-I S#"edule (&trition 1istory Gor$al 5a ily 1istory -rodu#t of #onsangu neous $arr age/ 2 elder s bl ngs7 t"ere s " story of s $ lar ras" n elder brot"er and #ous n. +ocial 1istory 0 ddle #lass @a$ ly *;a ination 6(eragely bu lt an #ter # #" ld "a( ng ( tals :. N 114>$ n+ .. N 32>$ n+ Te$&erature N F'0@ We g"t N 14 Mg+ Eengt" N '2 #$+ @;C N 4' #$ %(+ Cons# ous+ or ented :a( ng dysart"r a ! t" s#ann ng s&ee#" :or ,ontal nystag$us of 02 :, fre?uen#y 6##entuated on e)tre$es of lateral ga,e Cran al ner(es nta#t Tone+ &o!er and refle)es are nor$al 24

-lanters b lateral do!n go ng 6bdo$ nal refle)es nor$al. W de based stagger ng ga t Go!er s gn absent ,es8iratory +yste *;a ination H laterally #lear 3astrointestinal tract *;a ination Soft+ non<tender+ Go (es#ero$egaly %ardio9asc&lar +yste *;a inationBUnre$ar%able

At the end of the odule students should !e a!le to"# Correlate $ #rostru#ture of #erebellu$ to fun#t on. Correlate fun#t onal anato$y of #erebellu$ to (ar ous #l n #al &resentat ons n #erebellar d seases. Des#r be t"e fun#t onal un t of Cerebellar #orte) Correlate $ #rostru#ture of #erebellu$ to fun#t on. Correlate fun#t onal anato$y of #erebellu$ to (ar ous #l n #al &resentat ons n #erebellar d seases

+KI.. Ident fy t"e gross features of #erebellu$ on t"e g (en $odel>s&e# $en. Ident fy t"e $ #ros#o& # features of #erebellu$ on t"e g (en sl de. -erfor$ #l n #al e)a$ nat on of #erebellar fun#t ons

:o! do anato$ #al d ( s ons of #erebellu$ #orrelate ! t" fun#t onal d ( s onJ 25

:o! does #erebellu$ re#e (e ts n&ut and fro$ !"ereJ :o! does #erebellu$ affe#t $otor a#t ( t esJ W"at s t"e bas s of s gns seen n #erebellar d sordersJ W"y t" s &at ent falls on one s de of t"e bodyJ :o! s balan#e $a nta nedJ :o! #erebellu$ &erfor$s n" b tory fun#t on

22

)1*$* A 0=
PA)I*() WI)1 ,*+)I(3 ),*$',< +1-55.I(3 3AI)< $A+KB.IK* 5A%*

Introd&ction to %A+*/ 6 5'<year<old $an !as seen by a neurolog st be#ause "e "ad not #ed t"e de(elo&$ent of a sl g"t tre$or of " s left "and. T"e tre$ors n(ol(ed all of t"e f ngers and t"e t"u$b and !ere &resent at rest but #eased dur ng (oluntary $o(e$ent. ;n e)a$ nat on+ t"e &at ent tended to &erfor$ all " s $o(e$ents slo!ly+ and " s fa#e "ad (ery l ttle e)&ress on and !as al$ost $as%l %e. ;n &ass (ely $o( ng t"e &at entOs ar$s+ t"e neurolog st found t"at t"e $us#les s"o!ed n#reased tone+ and t"ere !as a sl g"t 8er%y res stan#e to t"e $o(e$ents. W"en as%ed to stand u& stra g"t+ t"e &at ent d d so but ! t" a stoo&ed &osture+ and !"en "e !al%ed+ "e d d so by s"uffl ng a#ross t"e e)a$ n ng roo$. Past 1istory/ :y&ertens (e for 10 years+ ta% ng drugs rregularly 5a ily 1istory/ 3 sons and 2 daug"ters+ all are "ealt"y and $arr ed +ocial 1istory/ Helongs to lo!er $ ddle so# al #lass *;a ination/ 3P*/ 6n old $an ! t" $as%<l %e fa#e+ !ell or ented and alert ! t" sl g"tly "y&o&"on # (o #e. H.-/ 130>'0 $$:g+ -ulse/ F0>$ n+ Te$&/ 6febr le+ .>./ 1'>$ n 1ead/ Tre$ors of t"e "ead %(+/ 1i"her cortical f&nctions/ Cons# ous+ 6#t (e %ranial (er9e/ Inta#t +ensory +yste / Tou#"+ &ressure+ ( brat on+ t!o &o nt d s#r $ nat on+ &a n and te$&erature+ sensat on are nta#t. $otor +yste / Tre$ors of all e)tre$ t es+ !orse on r g"t s de es&e# ally at rest. BCog!"eelC r g d ty of t"e r g"t ar$ Hot" "ands s"o!ed f ngers ta&& ng and ra& d alternat ng $o(e$ents 0us#le &o!er !as 5>5 t"roug"out Slo! staff ga t ! t" stoo&ed &osture+ s"ort ste&s and de#reased ar$ s! ng E)" b t retro&uls on of t!o ste&s !"en &ulled gently ba#%!ards

27

Class fy d sorders asso# ated ! t" basal nu#le Correlate t"e stru#ture of t"e (ar ous basal nu#le ! t" t"e r fun#t on Correlate t"e #onne#t ons of basal nu#le to t"e r fun#t ons. D fferent ate bet!een &uta$en and #audate # r#u t .elate bas s of d sorders asso# ated ! t" basal nu#le . Des#r be t"e synt"es s+ fun#t ons and degradat on of neurotrans$ tters n(ol(ed n fun#t on ng of basal nu#le Des#r be drugs $od fy ng t"e fun#t ons of neurotrans$ tters n basal nu#le .

:o! !ould you relate t"e features of t" s #ond t on ! t" fun#t on ng of basal nu#le J

2'

)1*$* A 0C
A %1I.D WI)1 A .A,3* 1*AD A(D D+-(+*)7 APP*A,A(%* '5 *2*+

Introd&ction to %A+* PYQ+ 3 $ont"s $ale #" ld+ .es dent of 6,ad Mas"$ r !as !ell 4 days ba#% !"en "e de(elo&ed fe(er !" #" !as " g" grade #ont nuous+ follo!ed by rr tab l ty and feed relu#tan#e by 1 day. :e also "ad (o$ t ng $ult &le e& sodes follo! ng feed. : s $ot"er told t"at "e "ad @e(er A 4 days Irr tab l ty and feed relu#tan#e A 3 days @ ts A 1 e& sode on day of ad$ ss on C" ld "ad an e& sode of general ,ed ton #<#olon # f ts last ng 4<5 $ nutes 3 "ours ba#%. +yste ic Inq&iry Got s gn f #ant Past 1istory Ins gn f #ant #irth 1istory Une(entful De9elo8 ental 1istory :ead "old ng+ so# al s$ le &os t (e 4accination 1istory U& to date (&trition 1istory ;n breast feed ng+ !ean ng started at 5 $ont"s of age. 5a ily 1istory o -rodu#t of #onsangu neous $arr age. o 2 elder s bl ngs bot" al (e and "ealt"y. o Go " story of f ts or e& le&sy n t"e fa$ ly. +ocial 1istory 0 ddle #lass @a$ ly *;a ination Irr table+ let"arg # #" ld "a( ng ( tals/ :. N 144>$ n+ .. N 52>$ n+ Te$&erature N 1010@ We g"t N 5.5 Mg+ Eengt" N 55 #$+ @;C N 3' #$ %(+ Irr table+ let"arg # 6nter or fontanelle< bulg ng Tone+ &o!er and refle)es< Gor$al 2F

-lanters b lateral< u& go ng 6bdo$ nal refle)es< Gor$al Cran al ner(es< Inta#t ,es8iratory +yste *;a ination Go lo!er #"est n dra! ngs H laterally #lear 3astrointestinal tract *;a ination Soft+ non<tender Go ( s#ero$egaly %ardio9asc&lar +yste *;a inationB Unre$ar%able %o&rse of Ad ission C" ld !as ad$ tted and n(est gated. Started on broad s&e#tru$ II ant b ot #s n $en g t # doses+ along ! t" su&&ort (e #are @e(er $&ro(ed after 32 "ours of start ng ant b ot # t"era&y+ and #" ld started ta% ng oral feed C" ld de(elo&ed gradually n#reas ng "ead # r#u$feren#e start ng 5t" day of ad$ ss on. Sun set s gn !as &os t (e on 7t" day of ad$ ss on.

At the end of the odule students should !e a!le to"# Corelate t"e anato$y of (entr #ular syste$ of bra n ! t" &rodu#t on and # r#ulat on of CS@. Des#r be t"e regulat on of #erebral blood flo!. Des#r be for$at on+ # r#ulat on and dra nage of CS@. State effe#ts of n#reased ntra#ran al &ressure and #orrelate t"e$ ! t" s gns and sy$&to$s.

W"at s t"e d fferen#e bet!een t"e #o$&os t on of CS@ and &las$aJ W"y CS@ s essent al for nor$al bra n fun#t on ng :o! blood CS@ barr er s for$ed and !"y s t s gn f #antJ

30

:o! does ele(ated ntra#ran al &ressure &resentJ W"at s t"e bas s of t" s &resentat onJ :o! does "ydro#e&"alus &resent n an adultJ :o! does sunset a&&earan#e o##ur W" #" $alfor$at ons of ner(ous syste$ lead to "ydro#e&"alusJ

31

)1*$* A 0E
2'-(3 3I,. '#+*++*D WI)1 5I3-,*

Introd&ction to %A+*/ 6 12ByearBold "irl 0as taken by her other to a 8hysician beca&se she 0as ra8idly losin" 0ei"ht. )he other stated that the 0ei"ht loss started abo&t 1 year a"o. )he eatin" habits had chan"ed fro eatin" 8ractically anythin" 8&t before her to bein" a 9ery choosy eater. 1er 8ersonality had also chan"ed< and she feared eetin" stran"ers. 1er relati9es had noticed that she 0as i 8atient and irritable and 0o&ld cry a "reat deal. Past $edical 1istory/ :as been healthy child thro&"ho&t her school life and has been ad9ised by her friends to lose 0ei"ht. +he has started &sin" 9ario&s 0ei"ht loss strate"ies< 0itho&t 8ro8er "&idance< fro the be"innin" of her teena"e. 5a ily 1istory/ &arents al (e +ocial 1istory/ belongs to u&&er so# oe#ono$ # #lass *;a ination/ 3P*/ %(+/ 1i"her cortical f&nctions/ intact %ranial ner9es/intact $otor f&nctions/intact +ensory syste /intact An;io&s lookin" 8ale Pro inent cheek bones and cla9icles P&lse/C0F in #P/G0FC0

At the end of the odule students should !e a!le to"# Correlate t"e stru#ture of "y&ot"ala$us to ts fun#t ons. .elate t"e role of "y&ot"ala$o<"y&o&"yseal &ortal syste$ to ts stru#ture. 32

6sso# ate #l n #al &resentat on of "y&ot"ala$ # d sorders to res&e#t (e nu#le . Correlate t"e stru#ture of "y&ot"ala$us to ts fun#t ons. .elate t"e role of "y&ot"ala$o<"y&o&"yseal &ortal syste$ to ts stru#ture. 6sso# ate #l n #al &resentat on of "y&ot"ala$ # d sorders to res&e#t (e nu#le . Des#r be (egetat (e and endo#r ne fun#t ons of "y&ot"ala$us and t"e r role n l $b # syste$

:o! s "y&ot"ala$us #onne#ted to & tu taryJ W"at s t"e role of "y&ot"ala$us n $a nta n ng # r#ad an r"yt"$J W" #" autono$ # a#t ( t es are #ontrolled by "y&ot"ala$usJ :o! do t"e fun#t ons of "y&ot"ala$us &lay t"e r role n sy$&to$s e)" b ted by t"e g rlJ

33

)1*$* A 0G
PA)I*() WI)1 -(I.A)*,A. .I$# PA,A.2+I+ A(D +P**%1 DI+',D*,

Introd&ction to %A+* 6 70 year fe$ale &resented n t"e E. ! t" C>; sudden onset of !ea%ness of r g"t s de of body asso# ated ! t" d ff #ulty n s&ea% ng. S"e !as n "er usual state of "ealt" !"en n e(en ng at tea s"e de(elo&ed sudden !ea%ness of r g"t s de of body K d ff #ulty n s&ea% ng. 6##ord ng to "er son s"e !as alert K #ons# ous but #ould not stand nor s&ea% fluently. Past $edical 1istory S"e s a %no!n "y&ertens (e for t"e last 10 years and s on regular ant "y&ertens (e $ed #at ons. S"e s not d abet #. 5a ily 1istory S"e s a ! do! and "as a daug"ter and a son. S"e l (es ! t" "er son and "er daug"ter n la! ta%es #are of "er. 6ll "er fa$ ly s "ealt"y. +ocioecono ic 1istory S"e l (es ! t" "er son n a rented a&art$ent. :e s a la!yer and earns around .s.50 000>$ont". Personal 1istory S"e s a non s$o%er. S"e "as no %no!n allerg es. *?A$I(A)I'(/ 3P*/ s"e s alert and #ons# ous ! t" ( tals of H.170>100 $$"g -ulse F4b&$ regular Te$& F' 0@ .>. 14>$ n %hest/ Unre$ar%able 3I)/ Unre$ar%able %4+/ :eart sounds nor$al ! t" no added sounds. Go #arot d bru t. %(+/ :0@< Inta#t ! t" GCS 15>15 E)&ress (e dys&"as a. ;t"er C.G nta#t Tone n#reased on r g"t s de Du&&er and lo!er l $b9 -o!er redu#ed 2>5 on r g"t s de DU&&er K lo!er l $b9 .efle)es/ an%le K %nee refle) br s%. . g"t &lantar u&go ng or entensor res&onse. Ga t A :e$ &leg # 34

Cerebellu$ and sensat ons/ Inta#t

At the end of the odule students should !e a!le to" Des#r be t"e to&ogra&" #al anato$y of #erebru$. Correlate $ #rostru#ture of #erebru$ to ts fun#t ons. 6sso# ate sul# and gyr ! t" #ort #al fun#t ons. Des#r be t"e (as#ular su&&ly of #erebru$ State t"e fun#t onal losses asso# ated ! t" t"e les ons of f ber bundles n #erebru$. Des#r be fun#t ons of &r $ary $otor #orte)+ -re$otor area and Su&&le$entary $otor area and so$est"et # asso# at on area D fferent ate bet!een &yra$ dal and E)tra&yra$ dal syste$ Inter&ret t"e effe#ts of les ons of &yra$ dal &at"!ay at d fferent le(els. Correlate t"e effe#ts of #erebral (as#ular o##lus on to #l n #al &resentat ons. Des#r be t"e fun#t ons of frontal lobe Des#r be t"e fun#t ons e)#lus (e to ea#" "e$ s&"ere Des#r be t"e $e#"an s$ by !" #" body $a nta ns tone and &osture Des#r be &r n# &les of learn ng and learn ng t"eor es. Des#r be t"e role of #erebral "e$ s&"ere n &rodu#t on of $ean ngful s&ee#" D fferent ate bet!een sensory and $otor a&"as a*s. Corelat r s% fa#tors of stro%e ! t" ts -.EIEGTI;G +KI.. Ident fy t"e $ #ros#o& # features of #erebru$ on t"e g (en sl de. Ident fy t"e gross features of #erebral #orte) on t"e g (en s&e# $en>$odel De$onstrate t"e #l n #al $et"ods n(ol(ed n 0otor syste$ e)a$ nat on on g (en sub8e#t.

:o! s t"e %no!ledge of sul# and gyr useful for understand ng #erebral fun#t onJ :o! do d fferent areas of #erebral #orte) ntegrate ! t" ea#" ot"erJ W"at fun#t ons are &erfor$ed by frontal lobeJ :o! !ould you relate le sons of &refrontal #orte) ! t" s#" ,o&"ren a and &ersonal ty d soreders. W" #" areas of #erebral #orte) are affe#ted by o##lus on of $ ddle #erebral arteryJ W"at !ould be out#o$eJ 35

:o! does loss of blood su&&ly affe#t (ar ous lobes of bra nJ :o! s #erebral do$ nan#e deter$ nedJ W"at fun#t ons are e)#lus (e to ea#" "e$ s&"ereJ :o! does #erebral #orte) &art # &ate n $otor a#t ( t esJ :o! does t"e #erebral "e$ s&"ere #oord nate n &rodu#t on of $ean ngful s&ee#"J W"ere do #ollaterals fro$ #ort #os& nal tra#t goJ W"at s t"e r s gn f #an#eJ W"at s t"e role of #or&us #allosu$ n nor$al fun#t on ng of bra nJ

32

)1*$* A 0H
I(A#I.I)2 )' ,*%A.. ,*%*() *4*()+

Introd&ction to the %A+*/ 1istory of Present Illness/ 6 &at ent na$ed Har%at 6l + age 70 years !as broug"t to neurology #l n # for #onsultat on by " s son be#ause of se(ere &rogress (e $e$ory &roble$s o(er t"e last 4 $ont"s. 6t basel ne t"e &at ent "ad nor$al #ogn t on+ e)er# sed a( dly and $a nta ned an a#t (e s#"edule+ try ng to %ee& a&&o nt$ents ! t" fr ends and bus ness asso# ates. Ten days &r or to ad$ ss on "e $et a fr end for lun#" n a #lub and "ad a nor$al+ #lear &re# se #on(ersat on e)#e&t t"at "e d d not re$e$ber t"e na$e of t"e !a ter "e "ad %no!n for se(eral years. @our days later+ t"e sa$e fr end s&o%e to Har%at on &"one and d s#o(ered t"at "e "ad no re#olle#t on of "a( ng lun#" or of day of t"e r #on(ersat on. :e see$ed nor$al ot"er! se. T"e ne)t day+ "e $ ssed $&ortant bus ness $eet ngs. W"en " s son tal%ed to " $ o(er subse?uent days " s #on(ersat on see$ed a&&ro&r ate e)#e&t "e !as totally una!are of #urrent e(ents+ n#lud ng a re#ent #r #%et $at#". Past history/ Controlled "y&ertens (e Go " story of d abetes or al#o"ol s$ 5a ily history/ T!o sons +e$&loyed n &r (ate #o$&an es +ocial history/ 6 se$ ret red r #" bus ness$an *?A$I(A)I'(/ 3P*/ 6 "ealt"y loo% ng old aged $an #o$&letely rela)ed -ulse/ 74>$ n Te$&/ 6febr le+ .>./ 1'>$ n %(+/ 1i"her cortical f&nctions/ Cons# ous+ a#t (e+ #oo&erat (e ;r ented n t $e &la#e and &erson .e$ote $e$ory s nta#t Inab l ty to re#all re#ent e(ents 0 ld tenden#y to #onfabulate %ranial ner9es/ Inta#t +ensory syste / Inta#t $otor syste / Inta#t %4+< ,es8iratory syste < Abdo en/ unre$ar%able 37

At the end of the od&le st&dents sho&ld be able to/B Des#r be t"e fun#t ons of l $b # syste$ and d sturban#es of be"a( or. ;utl ne &sy#"olog #al bas s and fun#t ons of e$ot ons.D&sy#" atry9 D fferent ate bet!een &r $ary and se#ondary e$ot ons. Des#r be t"e role of &os t (e e$ot ons on "ealt" ;utl ne "o! #ulture effe#ts t"e e)&ress on of e$ot ons D s#uss t"e fa#tors affe#t ng $ental "ealt". Des#r be $e#"an s$ of #ogn t on+ $e$ory tra#es+ ass $ lat on+ retr e(al and a&&l #at on. Class fy $e$ory. D fferent ate bet!een s"ort+ nter$ed ate and long ter$ $e$ory. Des#r be "o! IR s der (ed and su$$ar ,e t"e not ons of su##essful ntell gen#e +KI.. Ident fy t"e d fferent &arts of l $b # syste$ on t"e g (en $odel. A))I)-D* De$onstrate te#"n ?ues to $&ro(e $e$ory

W"at s l $b # # r#u tJ W"at s t"e role of l $b # syste$ n $e$ory and e$ot onsJ W"at do you t" n% s t"e role of t"ala$us n $e$oryJ D fferent ate bet!een retrograde and anterograde a$nes a. W"y !e are able to re$e$ber t" ngsJ W"y !e don*t re$e$ber $ost of t"e t" ngs after $any days "a(e &assedJ W"at s t"e role of neurotrans$ tter n $e$oryJ

3'

)1*$* A 10
PA)I*() WI)1 -(I.A)*,A. D,''PI(3 *2*.ID< %'(+),I%)*D P-PI.< D,2 5A%*

Introd&ction to %A+* 6 42<year<old $an !"o "ad re#ently undergone r g"t<s ded &neu$one#to$y for #ar# no$a of t"e bron#"us !as seen by " s t"ora# # surgeon for follo!<u& after t"e o&erat on. T"e &at ent sa d t"at "e felt sur&r s ngly f t and !as ga n ng so$e of t"e !e g"t t"at "e "ad lost &r or to t"e o&erat on. : s ! fe #o$$ented t"at about 1 !ee% ago+ t"e u&&er l d of " s r g"t eye tended to dro& sl g"tly !"en "e !as t red at t"e end of t"e day. 6fter a #areful &"ys #al e)a$ nat on+ t"e surgeon not #ed t"at n add t on to t"e &tos s of t"e r g"t eye+ t"e &at entOs r g"t &u& l !as #onstr #ted and t"at " s fa#e !as sl g"tly flus"ed on t"e r g"t s de. Past edical history/ :e !as d agnosed as a #ase of broon#"ogen # #ar# no$a 2 $ont"s ago. 5a ily history/ : s fat"er d ed of lung #an#er +ocial history/ s$o% ng for &ast 25 year Dr&" history/ :as been ta% ng $ed #at on for #an#er. *?A$I(A)I'(/ 3P*/ 6 $ ddle aged+ an) ous loo% ng $an !as !ell or ented n &erson+ &la#e and t $e t"e s% n on t"e r g"t s de of fa#e !as dr er and !ar$er t"an t"e left s de. -ules ''>$ n+ H-/ 130>70$$ Te$&/ 6febr le E)a$ nat on of ne#% re(ealed a "ard+ f )ed ly$&" node n r g"t su&ra#la( #ular reg on. *ye e;a ination/ . g"t &u& l s #onstr #ted . g"t eyel d &tos s. Eeft eye nor$al %(+/ 1i"her cortical f&nction/ Inta#t %ranial ner9es/ Inta#t $otor syste / Inta#t +ensory syste / Inta#t ,es8iratory syste / S#ar $ar% ( s ble on r g"t s de of #"est ;n aus#ultat on+ absent breat" sound on r g"t s de of #"est %4+ and Abdo en/ unre$ar%able

3F

At the end of the odule students should !e a!le to"# Des#r be stru#tural and fun#t onal organ ,at on of 6GS. .elate t"e $ode of a#t on of sy$&at"et # neurotrans$ tters to t"e r effe#ts on target organs. .elate t"e $ode of a#t on of &arasy$&at"et # neurotrans$ tters to regulat on of body fun#t ons. Des#r be t"e $e#"an s$ of a#t on of drug grou&s $odulat ng t"e fun#t ons of 6GS . (8har a!

:o! does autono$ # ner(ous syste$ #o$&are ! t" t"e so$at # ner(ous syste$ n ts organ ,at onJ :o! !ould you relate &neu$one#to$y ! t" t"ese sy$&to$sJ Dur ng e)er# se !"y blood flo! to t"e $us#les n#rease !"en at t" s sa$e t $e blood flo! to GIT and ur nary syste$ s de#reasedJ W"at s f g"t<fl g"t res&onseJ W"at s t"e bas s of &tos s and &u& llary #onstr #t on n :orner*s syndro$eJ

40

A%K('W.*3*$*()+ Study gu de s not an nd ( dual effort of t"e $odule #oord nator. It s not &oss ble ! t"out t"e su&&ort of tea$. I also ! s" to e)&ress $y grat tude to t"e tea$ $e$bers for t"e r "ours of !or%+ suggest ons+ tre$endous &at en#e and en#ourage$ent. T"ey "a(e "ad t"e &at en#e and been ! ll ng to &ro( de ass stan#e and en#ourage$ent dur ng t"e &re&arat on of $odule. 0y s&e# al t"an%s to Dr. 0una,,a for "el& ng n organ ,at on of #ontent. I also t"an% Dr. 0obeen+ Dr. .u%"sana n "el& ng to turn #ontents nto a study gu de. S n#ere t"an%s to Dr. 6$breen and Dr. Qees"an+ !"o de(elo&ed t"e #ases. ;ur #o$&uter o&erator 0r. H lal "as been #ons stently "el&ful and " s efforts are a&&re# ated for for$att ng t"e study gu de.

.*A,(I(3 ,*+'-,%*+
1. 2. 3. 4. Cl n #al Geuroanato$y<-atr #% Snell Te)tboo% of 0ed #al -"ys ology< Guyton and :all T"e De(elo& ng :u$an< 0oore and -ersaud 3un?ue ra*s Has # : stology

Additional ,eadin" 1. Harr*s T"e :u$an Ger(ous Syste$ 2. .e( e! of 0ed #al -"ys ology< Ganong

41